Background: Burnout has become endemic in medicine, across all specialties and levels of training. Grit, defined as "perseverance and passion for long-term goals," attempts to quantify the ability to maintain sustained effort throughout an extended length of time. Our objective is to assess burnout and well-being and examine their relationship with the character trait, grit, in emergency medicine residents.Methods: In Fall 2016, we conducted a multicenter cross-sectional survey at five large, urban, academically affiliated emergency departments. Residents were invited to anonymously provide responses to three validated survey instruments; the Short Grit Scale, the Maslach Burnout Inventory, and the World Health Organization-5 Well-Being Index.Results: A total of 222 residents completed the survey (response rate = 86%). A total of 173 residents (77.9%) met criteria for burnout and 107 residents (48.2%) met criteria for low well-being. Residents meeting criteria for burnout and low well-being had significantly lower mean grit scores than those that did not meet criteria. Residents with high grit scores had lower odds of experiencing burnout and low well-being (odds ratio [OR] = 0.26, 95% confidence interval [CI] = 0.46-0.85; and [OR] = 0.33, 95% CI = 0.16-0.72, respectively). Residents with low grit scores were more likely to experience burnout and more likely to have low well-being (OR = 6.17, 95% CI = 1.43-26.64; and OR = 2.76, 95% CI = 1.31-5.79, respectively).Conclusion: A significant relationship exists between grit, burnout, and well-being. Residents with high grit appear to be less likely to experience burnout and low well-being while those with low grit are more likely to experience burnout and low well-being.

Alumni self-evaluation of competence using the EM-Milestones provides valuable information concerning confidence to practice independently; these data, coupled with regular milestone evaluation of existing trainees, can identify problem areas and provide a blueprint for targeted programme improvement.